A review of several second-generation disease-modifying therapies (DMTs) found that these agents were not associated with an increased risk of psychiatric side effects in patients with multiple sclerosis (MS). The findings were published online in the journal Multiple Sclerosis and Related Disorders.

To investigate the link between second-generation DMTs and adverse psychiatric effects, the authors searched various databases for studies involving MS patients treated with one of the following DMTs: alemtuzumab, dimethyl fumarate (DMF), fingolimod, natalizumab, or teriflunomide. The primary outcome measure of the study was the frequency of any adverse psychiatric effect observed during treatment with one of these agents. The authors also investigated the effect of treatment on depression and anxiety symptoms as a secondary outcome.

Related Articles

Seventy-eight studies were included in the analysis (48 randomized controlled trials, 28 observational studies, and 2 case reports), most of which involved natalizumab (N=30) or fingolimod (N=29). Among these studies, depression was found to be the most common adverse psychiatric effect reported, followed by anxiety. However, none of the agents evaluated were associated with a statistically significant increased risk for these effects. Of the 18 studies that assessed changes in depression or anxiety following treatment with fingolimod, natalizumab or DMF, only fingolimod was tied to statistically significant improvement in depressive symptoms.

“Fingolimod may have a slight beneficial effect on symptoms of depression,” the authors concluded, “This may reflect either a positive direct effect (eg, immune modulation) or an indirect effect arising due to a positive impact on disease activity or course.”